Several new Stark law initiatives have recently gone into effect, yet the application of those provisions is unclear to many healthcare professionals and patients.
Online PR News – 22-April-2013 – Irving, Texas – IRVING, TEXAS (April 16, 2013)… Several new Stark law initiatives have recently gone into effect, yet the application of those provisions is unclear to many healthcare professionals and patients.
“A common misunderstanding is that Stark law applies across the board to all patients, but it does not,” says Dr. Carol Mahon, chief compliance officer of Minimally Invasive SpineCARE® and CEO of Medical Business Institute. “Stark law only applies to government-funded entities – like Medicare and Medicaid.
“There are safe harbors or exceptions to the law that could affect a lot of people who don’t know about them,” continues Dr. Mahon. “That’s why it’s important to educate yourself on the law. This is especially true for anyone who works in the healthcare industry.”
Stark law exceptions include subjects such as lease exceptions, professional courtesies and specific instances where physicians can waive a co-pay or deductible from a Medicare or Medicaid patient.
“Normally you cannot waive a co-pay or deductible, but there are a few exceptions. Understanding what they are and when they apply is beneficial for physicians and for anyone on Medicare or Medicaid who might be affected by it,” adds Dr. Mahon.
Under the new provisions, exceptions can be made:
• When paying the co-pay or deductible would cause a financial hardship on a patient.
• When the healthcare professional wishes to offer a professional courtesy to another physician.
• When the healthcare professional has tried to collect the patient portion but has been unsuccessful and is forced to write it off as bad debt.
Stark law is a healthcare reform bill named for U.S. Congressman Pete Stark, who initially sponsored it. It was designed to curb physician self-referrals – instances where a physician refers a patient to a medical facility in which he or she has a financial interest. The law is intended to encourage competitive pricing and limit the over-utilization of services such as lab testing and mark-ups, which can increase health care costs.
The bill has been implemented in three phases. Several of the final phase requirements were officially rolled out this January and they are being implemented by healthcare professionals nationwide. One such requirement, which will impact many healthcare professionals, considers a physician to "stand in the shoes'' of a physician organization where he or she is a member.
“Primarily, these provisions were created to close a perceived loophole in Stark law. In most cases, Stark law prohibits a physician from referring Medicare patients to an entity furnishing DHS if the physician or a family member has a financial relationship it. The Phase III ‘stand in the shoes’ provisions indicate that the referring physician has the same direct compensation arrangements as the medical practice, even if the relationship is with the practice and not with the doctor,” explains Dr. Mahon.
The Phase III “stand in the shoes” provisions further define the “physician organization” to include professional corporations, physician practices and group practices, and it clarifies the parties that are affected. The expansion of these provisions has changed the treatment of many arrangements previously considered to be outside the reach of or in compliance with Stark law. In the months to come, many of these hospital and physician lease arrangements will require restructuring.
“Anyone who’s interested in learning more about Stark can visit the Medicare & Medicaid Services website, cms.gov. It has a lot of helpful information,” says Dr. Mahon.
Dr. Mahon adds that Stark is a federal law, with civil implications, not legal ones. Noncompliance will not result in jail time, but it could have hefty fines.
Dr. Mahon has more than 40 years of experience in the medical field. She is the chief compliance officer for Minimally Invasive SpineCARE, a nationally acclaimed spine center located in the Dallas/Fort Worth Metroplex. She’s also the president and CEO of Medical Business Institute, a medical education and consulting firm that educates healthcare professionals on the business aspects of medicine, including Stark compliance. She sits as a volunteer professional on the U.S. Senate Select Advisory Panel for Coding and Nomenclature and on the U.S. Senate Select Advisory Panel for CLIA/OSHA Rules Assessment. In addition, Dr. Mahon has served as an adjunct professor or guest lecturer at a number of medical schools, teaching hospitals or other healthcare facilities, such as The Cleveland Clinic, UMDNJ, Harvard University, Stanford University, The University of Texas and Texas Tech Medical School.
Minimally Invasive SpineCARE® is a nationally acclaimed, fully comprehensive spine center for surgical and non-surgical treatments. Headquartered in Irving, Texas, Minimally Invasive SpineCARE has 12 clinics in the Dallas/Fort Worth Metroplex. Services include pain mapping and other diagnostic services, adult stem cell therapy, surgical procedures, non-surgical treatments, and chiropractic and physical therapy. For more information, visit www.SpineCareDFW.com or call 1-888-600-6474. Connect with Minimally Invasive SpineCARE on Facebook, Twitter or YouTube/
Minimally Invasive SpineCARE® locations:
1851 Medical Center Drive, Decatur, TX 76234
1001 Robbie Mince Way, Desoto, TX 75115
9330 Poppy Drive, Ste. 500, Dallas, TX 75218
8750 North Central Expressway, Ste. 1750, Dallas, TX 75231
800 Eighth Avenue, Ste. 440, Fort Worth, TX 76104
4400 Heritage Trace Parkway, Ste. 208, Fort Worth, TX 76244
8501 Wade Boulevard, Ste. 270, Frisco, TX 75034
5224 South State Highway 360, Ste. 230, Grand Prairie, TX 75052
4301 North MacArthur Boulevard, Ste. 101, Irving, TX 75038
6850 TPC Drive, Ste. 116, McKinney, TX 75070
4716 Alliance Boulevard, Pavilion 2, Ste. 218, Plano, TX 75093
1600 Republic Parkway, Ste. 100, Mesquite, TX 75150